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Nursing QUESTION #9227
Question 1
In a patient with Acute Respiratory Distress Syndrome (ARDS), what is the PRIMARY ventilation strategy supported by the ARDSNet trial?
  • High tidal volume ventilation at \(10-12 \text{ mL/kg}\) IBW to ensure adequate oxygenation
  • Low tidal volume ventilation at \(6 \text{ mL/kg}\) IBW with plateau pressure \(\leq 30 \text{ cmH}_2\text{O}\)✔️
  • Pressure control ventilation with PEEP set at \(20 \text{ cmH}_2\text{O}\)
  • Synchronized intermittent mandatory ventilation (SIMV) with pressure support of \(15 \text{ cmH}_2\text{O}\)
Correct Answer Explanation
Correct Answer: B — Lung-protective ventilation (ARDSNet Protocol)

The landmark ARDSNet trial (2000) demonstrated a 22% reduction in mortality using low tidal volume ventilation.

ARDSNet Lung-Protective Ventilation Strategy:
ParameterTarget
Tidal Volume (\(V_T\))\(6 \text{ mL/kg}\) IBW (can range \(4-8 \text{ mL/kg}\))
Plateau Pressure\(\leq 30 \text{ cmH}_2\text{O}\)
PEEPTitrated based on FiO\(_2\)/PEEP table
SpO\(_2\) target\(88 - 95\%\)
pH\(\geq 7.30\) (permissive hypercapnia allowed)
Rationale: High \(V_T\) causes volutrauma and barotrauma — key mechanisms of VILI. Low \(V_T\) limits overdistension while accepting mild hypercapnia (permissive hypercapnia).